Choi Jae Ho, Hong Jae-Young, Suh Seung-Woo, Yang Jae-Hyuk, Park Si-Young, Park Jung-Ho, Hong Sung-Jun
Korea University graduate school of medicine, Seoul, South Korea.
Department of Orthopedics, Korea University Ansan Hospital, Ansan, South Korea.
Pain Physician. 2016 May;19(4):293-8.
Epidural steroid injections have been gaining popularity as an alternative to surgical treatment of radicular pain with associated spinal derangement. To determine the effectiveness and indications of lumbar epidural steroid injections in patients with or without surgery, we performed a prospective observational study. We gathered data from 262 degenerative short-segment spinal disease patients (affected at one or 2 levels) with greater than 12 weeks of medication-resistant radicular pain without neurological deficits but with moderate disability (visual analog scale < 6.5; Oswestry Disability Index < 35). All patients received initial fluoroscopically guided transforaminal epidural steroid injections of the affected vertebral level(s) corresponding to their symptoms. Those with inadequate responses or who wanted subsequently surgery underwent decompression surgery. Clinical and demographic characteristics were assessed to compare the differences between the groups.
Of the 262 patients who received epidural steroid injections, 204 did not have operations for up to one year. However, 58 patients experienced inadequate relief of pain or wanted operations and therefore underwent surgery. At baseline, the 2 groups had similar mean disability indices and pain scores, as well as gender ratios, ages, and durations of symptoms (P > 0.05). In the patients who underwent surgery, the mean disability and pain scores were not significantly decreased after injection compared to those in the injection-alone group, although the scores for the injection plus surgery patients decreased significantly after surgery (P < 0.05). In contrast, patients who underwent epidural steroid injection alone experienced a significant decrease in disability and pain after injection, and that persisted up to one year of follow-up (P < 0.05). Epidural steroid injection can decrease the pain and disability in the majority of a moderate disability group for up to one year, although a significant number of patients underwent surgery regardless of injection. We recommend epidural steroid injection as a first-line treatment in patients with moderate disability that can be converted to surgery without significant delay.
Epidural steroid injection, spinal surgery, lumbar spinal disease, lumbar radiculopathy, lumbar radicular pain.
硬膜外类固醇注射作为伴有脊柱紊乱的神经根性疼痛手术治疗的替代方法，越来越受到欢迎。为了确定腰椎硬膜外类固醇注射在接受或未接受手术患者中的有效性和适应症，我们进行了一项前瞻性观察研究。我们收集了262例退行性短节段脊柱疾病患者（1个或2个节段受累）的数据，这些患者有超过12周的药物抵抗性神经根性疼痛，无神经功能缺损但有中度残疾（视觉模拟评分<6.5；奥斯维斯特里残疾指数<35）。所有患者均接受了对应于其症状的受影响椎体节段的初始透视引导下经椎间孔硬膜外类固醇注射。那些反应不足或随后想要手术的患者接受了减压手术。评估临床和人口统计学特征以比较两组之间的差异。
在接受硬膜外类固醇注射的262例患者中，204例在长达一年的时间里未进行手术。然而，58例患者疼痛缓解不足或想要手术，因此接受了手术。在基线时，两组的平均残疾指数和疼痛评分、性别比例、年龄和症状持续时间相似（P>0.05）。在接受手术的患者中，与仅接受注射的组相比，注射后平均残疾和疼痛评分没有显著降低，尽管注射加手术患者的评分在手术后显著降低（P<0.05）。相比之下，仅接受硬膜外类固醇注射的患者在注射后残疾和疼痛显著降低，并且这种情况持续到随访一年（P<0.05）。硬膜外类固醇注射可以在长达一年的时间里降低大多数中度残疾组的疼痛和残疾，尽管有相当数量的患者无论是否注射都接受了手术。我们建议将硬膜外类固醇注射作为中度残疾患者的一线治疗方法，这些患者可以在不显著延迟的情况下转为手术治疗。
硬膜外类固醇注射；脊柱手术；腰椎疾病；腰椎神经根病；腰椎神经根性疼痛
